The Rise of Health Care Sharing Ministries

Earlier this year, insurance regulators from both Texas and Washington state filed orders against Aliera Healthcare, a health care sharing ministry (HCSM), after some of its members filed complaints about denied or delayed payments on their medical claims.

At first glance, this may seem like business as usual in the insurance commissioner’s office. Yet, organizations like Aliera—religious groups where members pay a set monthly amount to share costs and help pay each other’s medical bills—are not insurance plans, per se. Rather, they are alternatives to ACA health plans that allow members to pay.

“HCSMs have been around since well before the ACA—the first ones came about in the 1990s,” says JoAnn Volk, a member of the Center on Health Insurance Reforms at Georgetown University who contributed to a 2018 Commonwealth Fund report discussing the risks of health care sharing ministries to consumers and insurance plans. “Think of them a bit like Amish communities who all come together, sharing resources and labor to build a neighbor’s barn. With these ministries, like-minded individuals can come together and share in each other’s medical costs.”

While, originally, members of such ministries may have flocked together because of shared religious beliefs, Volk says the ACA has pushed more people to consider these arrangements for other reasons.

“We are hearing about a lot of growth in HCSMs now,” she says. “And that increase in growth seems more spurred by people who are concerned about higher premiums for ACA coverage than truly believing in a ministry’s religious tenets. They can pay less per month and have confidence that they won’t be hit by with a mandate penalty. There’s only one problem: it’s not insurance and there is no actual promise that an HCSM will pay your medical bills.”

Related: The Future of the ACA

In fact, most HCSMs do not cover pre-existing conditions or preventative services. Due to their religious foundation, they also aren’t inclined to cover birth control, mental health services, or addiction treatment. In addition, there may be caps, or limits on the total amount that the group will pay for any single medical treatment. And more consumers are reporting that HCSMs are not paying their claims for medical care.

Despite those limitations, the number of memberships continues to grow. The Alliance for Health Care Sharing Ministries, the trade group that represents these groups, suggests that memberships have grown into the millions over the past few years. But it’s unclear whether or not that is accurate, says Volk. Unlike health insurance plan numbers, membership in HCSMs is not tracked by regulatory agencies. Nor do those agencies have much leverage to educate consumers about what HCSMs are required—and not required—to provide with membership or to intervene with consumer complaints.

“These organizations get a carve out from insurance regulations because they are not insurance,” she says. “But nomenclature that can be quite confusing to consumers. And even though they are required to say they are not insurance, it gets overwhelmed by all the insurance-like features they use to market and promote themselves. Again, there is no promise to pay—and members often don’t seem to realize that.”

Volk cites coverage options with descriptions like “bronze, silver, and gold,” as well as monthly contributions based on age and the number of people in your family that look and work much like the premiums one might see with insurance plans. And brokers who also sell ACA plans may also have HCSMs on their option lists, which make them seem like actual insurance plans.

It’s why many members are registering complaints. But with religious exemptions and other legislative protections in place, there is little recourse. Aliera, in fact, plans to fight the cease-and-desist action filed against them by Washington state.

“It really is a wild, wild west out there for fraudsters and aggressive marketing tactics with these kinds of organizations,” says Volk. “It’s been hard for state officials to step in and do anything. And as we hear more about stories about people not having their bills paid, it should raise pressure for states to take a fresh look on what they should be doing to protect consumers and providers from these HCSMs.”